It can be argued that money as well as life can be saved when patients who are suspected of having oropharyngeal dysphagia are properly evaluated. The objective of this proposal is to validate the use of an Internet based protocol for real-time, high resolution, interactive, remote, telefluoroscopic evaluation of swallowing. The investigators will achieve this goal by testing the hypothesis that oropharyngeal swallowing function can be evaluated with a similar level of interpretative accuracy by a qualified speech-language pathologist (SLP) via the telefluoroscopic procedure as it can when a qualified SLP is in the fluoroscopy suite using the traditional videofiuoroscopic method. The Principal Investigator and her staff were responsible for the development of the real-time, remote, Teledynamic Evaluation of Swallowing System (TESS). The fluoroscope interface computer (FIC) located at the remote hospital site is fully controlled by the control and analysis computer (CAC) which can be located any distance from the hospital. Images are viewed on the CAC in real time with a lossy format and, at the completion of the examination, the high resolution lossless images are then transmitted to the CAC. At the CAC, the swallows can be viewed at variable rates including frame-by-frame, and measures can be made of structure displacement and rate of bolus flow. A total of 100 patients from two medical centers will participate in this investigation. The investigators will obtain instrumental evaluations of swallowing function from each patient using a) traditional videofluoroscopy recorded onto videotape with subsequent interpretation and recommendations by an experienced SLP who is in direct contact with the patient and who performs all aspects of traditional evaluation and b) telefluoroscopy via real-time Internet transmission of dynamic video images to a distant site, allowing an off-site clinician to direct the fluoroscopic procedure, with image storage for subsequent interpretation and recommendations by the same off-site clinician who has had only indirect observation of the patient. Kappa (or weighted kappa as appropriate) and the 90% lower confidence limits as chance-adjusted measure of agreement for each clinical variable of interest and each treatment recommendation will be determined. McNemar's test will be used to detect possible over-diagnosis or under-diagnosis of certain clinical variables due to the use of telefluoroscopy. A secondary study will be performed to obtain agreement data based on interpretations of two clinicians on the same files using the tapes from traditional examination. Confirmation of the reliability of the telefluoroscopic evaluation can result in equity of access for underserved groups for whom SLPs with expertise in dysphagia diagnosis are locally unavailable. [unreadable] [unreadable] [unreadable]